The Cholesterol Craze: Statin Use Skyrocketed
9 CommentsBy Ed Silverman // June 25th, 2008 // 3:13 pm
Most likely, you will not find this surprising. In any event, the use of cholesterol-lowering pills - otherwise known as statins - rose by 156 percent between 2000 and 2005, according to the US Agency for Healthcare Research and Quality. The number of people obtaining a prescription for a statin nearly doubled, from 15.8 milllion to 29.7 million. Looked at another way, the number of outpatient scrips rose to nearly 174 million from about 90 million.
Along with the usage, the register rang innumerable times - spending jumped during that period to $19.7 billion from $7.7 billion. Each individual spent $484 a year, on average, to lower their cholesterol in 2000, and that rose to $661 by 2005. Although the AHRQ report doesn’t look at the past three years, the individual spending may have lessened with the introduction of generic Zocor last year.
Jack2
…and in addition to all that spending, many people benefited from lower cholesterol and reduced risk of cardiovascular adverse events.
Condor
Unless they chose to take Vytorin, of course, Jack.
Then all they did was pay triple — for better LDL Numbers — but experienced about the same, or, though not statistically-significant — moderately worse, outcomes.
But what do I know? Heh!
Anon
Not much, Condor, if you are basing your conclusions on a study of 720 patients vs. years of evidence in tens of thousands of patients on statin therapy and non-statin therapy that has consistently demonstrated the benefits of LDL lowering.
Even with these increases, a very large percentage of patients either aren’t treated or aren’t being treated to the LDL goals established by NCEP (NIH).
I agree with Jack. Many lives have been saved as a result of greater use of cholesterol lowering meds, and many more can be saved if we simply treat them more aggressively.
By the way Condor, how did that prediction of $16 / share for Schering turn out? I hope that you didn’t short too much of the stock.
Justice in MI
“…many more can be saved if we simply treat them more aggressively. ”
To me, this is faith-based medicine. The reality is that we don’t know mortality/morbidity for long-term use of statins at more “aggressive doses.” The little we do know does not suggest Lourdes.
We’ll find out. But we don’t yet know.
M Helm, MD
Actually, while the trend is up, and therefore positive for the manufacturers, the average number of prescriptions per patient changed only from 5.6 Rxs/patient/year in 2000 to 5.8 Rxs/patient/year in 2005.
Even when allowing an estimate for the number of new patients who start treatment during the course of the year, and the number who discontinue, their appears to be a problem with adherence. There MAY be reductions in LDL even with poor adherence, but likely not reduction in CV risk.
My assumptions are crude, but say 25% of the patients are new during a given year, and they are evenly distributed across all months. Assume also that 10% of previous users discontinue during the course of the year (again evenly distributed across the year). These 35% of patients should (on average) fill 6 prescriptions if perfectly adherent (which is very rare). The remaining 65% of patients should have started and ended the year on the med, so they should have filled 12 prescriptions. Do the math, and you will see that the average prescriptions per patient should really be around 10 per year if folks were perfectly adherent (which we know they aren’t).
The opinions and data I’ve seen, including some from our academic programs, indicates that to get the health benefit (not just improve the lab value), probably requires at least 75% adherence. That would put the estimate around 7.5 Rxs per patient per year.
Some folks are undoubtedly getting a benefit, but many are just wasting resources. The gap I see here also represents significant “lost” sales for the manufacturers. Probably, to fully realize the health/outcomes/societal benefits of these medications sales and prescriptions should have been about 30% higher.
Increased adherence to certain medications would be a benefit for everybody if there is a genuine health benefit. Some of the most progessive self-insured plans have recognized this, and the Asheville Project is a practical example. Strangely enough, I don’t see significant efforts going in this direction coming from PhRMA who 1) has the money to fund these, and 2) gets the lion share of the profit generated along the way. (The basic marketing principle here is that it is easier to keep a customer than find a new one.) If I’m wrong on this, I’d sure like to know.
Justice in MI
Terrific points, Dr. H. From what I recall, one study suggested that the rates of adherence for _new_ statin rx’s is not more than about 50% after one year.
Neers87
Anon,
Perhaps you should go back and check your history of LDL lowering and non statin therapy.
Specifically the HERS & Hers II data. Estrogen replacement therapy was all the rage for the beneficial effects of lowering LDL and the preceived benefit on morbidity and mortality. That didn’t work out too well!
Physicians continued to RX in even in light of surrogate marker evidence of non benefit. LDL was the target and Estrogen had a beneficial effect of lowering LDL.
Any of this sounding familiar?
So as far as the Body of Evidence is concerned, what Enhance contributes to the knowledge base is that it clearly does matter how you reduce LDL. At the present time HMG COA reductase inhibitory effects of Statins seems to be the most common denominator for benefit.
Atlex
M Helm,
Almost every major pharma company has significant resources dedicated to improving compliance directly and indirectly. Unfortunately, it is a very tough egg to crack despite yearsof efforts. You correctly cite the Asheville project and the lowering of co-pays to achive greater compliance. I know that 4 or 5 of the majors pharmas have been working to expand this approach (ie, value-based benefit design), but few employers have moved in that direction.
Atlex
M Helm, MD
Atlex,
Asheville involved some significant disease state management activities by pharmacists and other case-manager types too. Though I happen to think that lower copays on the needed/proven beneficial meds are a good thing. In theory one could design a “rewards” type program where incentives could be designed to maintain adherence.
There are a few (but only a few) self-insured plans which have worked on adherence and quality issues - Pitney-Bowes is the most famous. There is a health care quality consortium out of St. Louis as I recall which has a large number of big self-insured and commercial plans involved. They recognize the problem of poor adherence, along with other issues such as access to physicians and pharmacies. There have been some interesting innovations developed to the benefit of the covered individuals and the plans.
I’m all about value-based benefits. But as a clinician, I’m not seeing adherence programs being delivered to patients which are effective. I sort of think that if a portion of the Marketing budgets could be devoted to building call centers with case managers, and educational mailings to patients that would be more helpful than building call centers to help secure prior authorizations for medication coverage (only then to have the patient discontinue after 4 or 5 months). I think the barrier is that no one company “owns” enough of a disease state and has a long enough remaining pattent life to believe that they will get the pay-back they want.
I wonder if effectively addressing compliance would be best approached in partnership with the payers, and at the industry trade group level. That would mean not just PhRMA, but also the various pharmacy trade groups and MD and insurance/PBM industries.
This would require “outside-the-box” thinking. I believe a striking difference could be made in common diseases like asthma, diabetes, cardiovascular disease (secondary prevention primarily). I think there are opportunities with higher cost, more rare conditions as well (cystic fibrosis, multiple sclerosis, the host of autoimmune diseases, HIV infection).
Someday, I would like to hear someone say that the US has the greatest healthcare system in the world, and be able to believe that it is true.
Apologies if I’ve gone off-topic.